What do I ask/tell my new doctor about my mental health?January 27, 2014 1:21 AMSubscribe

I don't know what help I need anymore, or even if I need help. I have a lifelong history of depression and the past two and half years, I've experienced more life stressors than normal. The original reasons I made the appointment was to
a. get a new script for my anti-anxiety medication (which is also meant to help my depression), especially as I accidentally abruptly ceased it over 5 days ago, and
b. a referral to a new psychiatrist to prescribe ADHD medication.

However, I've been (lightly) in this system for a long time, with little to no improvement beyond a certain point, and I'm doubting whether medication helps (anymore), or even whether I'm actually even ill, and not simply lazy, lonely and prone to instant gratification. If I tell my new doctor my medical treatment over the last 5 years and/or answer the usual questions about depression and anxiety truthfully, I figure I'll get more of the same and I'm pretty disillusioned about treatment (both through medication and therapy). I'm coming to believe that this is just how (my) life is, and it's not fun, but it's not impossible to live with, and while the intermittent suicide ideation is unpleasant, I am not at risk of suicide.

How would you suggest I approach treatment? What should I ask my doctor?

More background Assessments: have included questionnaires about ADHD, anxiety, depression, CAT scan of brain, EEG, blood tests for numerous things.Medications: have most recently included dexamphetamine sulphate for ADHD, and duloxetine (Cymbalta) for anxiety and/or depression, Mirena IUD to minimise PMS. Treatments: have included a number of therapy sessions with psychologists including CBT and ACT.Life stressors: include end of marriage, mother dying, 4 moves, freelance and temp work to multiple clients, empty nest, commencing grad studies, ex being arrested for exposure to minor, daughter sexual assaulted, bad dating experiences, social isolation. My self care efforts: mindfulness, regularly returning to healthy eating/exercise plan, volunteering, trying AA (but where I am, unfortunately, they explicitly do not believe in atheists in AA).Location: Australia which means doctor & psychiatrist visits either free or very cheap, and also 6 free psychology visits per year.

I'm not sure what to ask your doctor, but I thought it worth mentioning that there are a couple of other options available to you via Medicare. One is that if you speak to your GP, you can get five subsidised allied health visits per year. You could use these on, say, an exercise physiologist or a dietitian who could help you develop a workout plan or dietary changes to support your mental health. They won't just tell you what to do, they'll listen to you and help you work through any obstacles until you have a plan that you'll actually stick to. You could talk to your psychiatrist about how best to use these sessions.

The other is that you're actually entitled to 12 subsided psychologist sessions (provided your GP says you need them) plus six group sessions a year. The group sessions can be used on an MBCT or MBSR course, if it's taught by a psychologist. If you haven't taken one already I really recommend it. I muddled along with my own mindfulness practice for years but I found that taking a course helped me understand things that, though they seem obvious now, I could never have figured out on my own. Having face to face contact with a teacher and a supportive group of fellow learners made all the difference. The courses are usually eight weeks long and two hours per class, so the subsidy won't cover the whole cost, but many teachers will offer a sliding scale if you're in need.

Also, tell your doctor everything you wrote above. The recommended treatments for people who have had multiple depressive episodes are different from those for people who are newly depressed. A good doctor should take this into account. (I can't find the citation right now but my understanding is that MBCT is one of the few treatments that have been shown to be more effective than antidepressants at preventing relapse in people who've had multiple episodes already).posted by embrangled at 2:40 AM on January 27, 2014 [2 favorites]

I think your stressors are off the charts! OMG, I could start to notice myself feeling numb just reading them! So, understand that you are going through a huge amount of difficult times now, and be gentle with yourself. Also, good for you for using this moment as an opportunity to consider what you want to do with your life and whether what you've been doing is still working for you.

Here in the States, if you go to a medical doctor, chances are high that you'll walk out with a prescription. I don't have anything against that if the meds are working for you, but clinical research strongly suggests that they don't work for everyone. You could try different pills (a psychiatrist would probably be helpful in this regard), and/or you could try doing different/more self-care.

Since you are in Australia, I wonder if it is possible for you to connect with Dr. Russ Harris? He's a medical practitioner, author, workshop leader, as well as one of the foremost practitioners of Acceptance and Commitment Therapy (ACT) in the world. His workshops and self-help books (esp The Happiness Trap) have changed people's lives. You can see him doing some lecturing on Youtube, if you like.

I wonder if you'd feel comfortable calling him to discuss your situation? If it's feasible, I'd try to see him, but otherwise, maybe he could make some recommendations about local therapists or other resources in your area. Take good care of yourself.posted by jasper411 at 12:16 PM on January 27, 2014 [1 favorite]

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